‘Significant’ savings with diclofenac vs. indomethacin for post-ERCP pancreatitis
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Key takeaways:
- There were no differences in rates of post-endoscopic retrograde cholangiopancreatography pancreatitis with indomethacin vs. diclofenac.
- Costs associated with each treatment were $731.04 and $0.92, respectively.
PHILADELPHIA — No significant differences were observed in post-endoscopic retrograde cholangiopancreatography pancreatitis with prophylactic diclofenac vs. indomethacin, with researchers also reporting savings of nearly $133,000.
“The cost of indomethacin suppositories has increased sharply in recent years,” Robin Wilson, MD, a third-year fellow in gastroenterology at the University of Rochester, said at the ACG Annual Scientific Meeting. “Diclofenac, however, is comparatively quite inexpensive and there are data to suggest that diclofenac and indomethacin are equally effective for post-[endoscopic retrograde cholangiopancreatography (ERCP)] pancreatitis prophylaxis.”
Wilson noted, however, that as diclofenac is not commercially available in the U.S., pharmacists at the University of Rochester compounded diclofenac suppositories for use in place of indomethacin in May 2023, providing an opportunity for cost comparison between the two.
Using pharmacy records, Wilson and colleagues identified 353 patients who received indomethacin (48.4%) between December 2022 and May 2023 or diclofenac (51.6%) between June and December 2023 for post-ERCP prophylaxis (PEP). The researchers also performed a retrospective chart review to assess patient demographics, procedural complexity and PEP rates.
Results demonstrated no significant differences in PEP rates between indomethacin (9.9%; 95% CI, 5.9-15.4) and diclofenac (4.9%; 95% CI, 2.3-9.2) groups. In addition, there were no significant associations between PEP and age, sex, procedural indication, prior sphincter of Oddi dysfunction, prior recurrent pancreatitis, cannulation technique or endoscopist.
Costs associated with each treatment of rectal indomethacin were $731.04 vs. $0.92 with diclofenac, for total costs of $125,007.84 vs. $167.44, respectively. From June to December 2023, use of diclofenac over indomethacin accrued a cost savings of $132,881.84.
“There does not appear to be a difference in terms of post-ERCP pancreatitis rates between patients who received indomethacin or diclofenac as prophylaxis and there were significant cost savings that are associated with diclofenac use for this indication,” Wilson said. “For any institution that has the means to do so, we would recommend considering making this change to result in cost savings for your center and your patients.”
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Wilson R, et al. Efficacy and cost savings with diclofenac suppository for post-ERCP pancreatitis: Experience from a tertiary care center. Presented at: ACG Annual Scientific Meeting; Oct. 25-30, 2024; Philadelphia (hybrid meeting).
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